7/6/2016 - idaho health care association...7/6/2016 14 phase incident personal: this incident is not...

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Armed Intruder and Active Shooterin the Long Term Care Facility

Plan…Respond…and Survive the Unthinkable

© 2015 Sorensen, Wilder & Associates

Presenter

•Dan Wilder

Professional Security Consultant, SWA (2006 – ) Director of Professional Services, SWA (2015 - ) HSEEP & CFATS Certified through USDHS CPTED Certified, National Institute of Crime Prevention Firefighter / EMT, Bradley, IL (2001 – )

On The Loose…Terror in the Streets

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Active Shooter Incidents…They’re Getting To Common

Seminar ObjectivesUnderstand• A State of PreparednessReview• Terminology and Concepts• Case StudyLearn• Active Shooter Safety Action Plan• Stress Control and Decision-Making• Safety Transition Adjustment Formula (STAF) ProtocolRemain• Safe and alive during an active-shooter incident

The prevailing attitude:“It won’t happen here.”

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Amish School ShootingNickel Mines, Pennsylvania

On October 2, 2006, Charles Robertsstormed a one-room schoolhouse inNickel Mines, Pennsylvania. He tookhostages and shot 10 Amish girls (ages6 to 13) before committing suicide.Five of the children died.

Even Hollywood is in on it…

Creating a State of Preparedness

Armed Intruder and Active Shooter in the Long Term Care Environment:Plan…Respond…and Survive the Unthinkable

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Golden West Towers Senior CommunityNovember 20, 2012 • Torrance, CA

A male resident inhis 80s shot andkilled two females(a 54-year-oldfacility managerand 54-year-oldcaregiver) in thelobby beforeturning the gun onhimself.

Double Murder–Suicide:

Pablo Davis Elder Living CenterOctober 20, 2013 • Detroit, MI

A 65-year-old male residentshot and killed two femaleresidents at the center afterretrieving a rifle from hisroom. The shootingstemmed from a breakupwith his girlfriend that heblamed on the two women.

Double Murder:

Abington ManorNovember 4, 2013 • South Abington, PA

Murder-Suicide:A 42-year-old staff nurseshot a resident to deathat a nursing home whereshe worked and thenturned the gun onherself.

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Mercy Fitzgerald HospitalJuly 24, 2014 • Darby, PA

A psychiatric patientpulled out a revolverfrom his waistband andexecuted hiscaseworker beforeturning the gun to hisdoctor. Dr. Silverman,shot also, pulled hisown gun and woundedthe assailant.

Murder and Gunfight:

Think About Your EmergencyOperations Plan…

It probably addresses a lot of possibilities…

Amberwood Gardens Skilled Nursing and Rehab CenterJune 25, 2011 • San Jose, CA

One killed and six injured

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Hurricane SandyJersey City Town HallOctober 29, 2012 • Jersey City, NJ

‘Superstorm Sandy’caused an estimated68 billion dollars indamages and killed148 people. Thehurricane affected24 states includingthe entire easternseaboard of the US.

Greenbriar Nursing Care CenterMay 22, 2011 • Joplin, MO

EF-5 tornado:159 people killed,including 16 atGreenbriar

West Fertilizer CompanyApril 17, 2013 • West, Texas

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West Rest Haven Nursing Home

The Active Shooter Plan isAnother Tab in Your EOP

Reaction to Disaster or Crisis

It’s not what you think.

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Failure to Respond

• Subconscious need for normalcy• Overwhelming sense of denial• Unable to comprehend scope of event• Optimistic bias• Lack of safety culture• No planning or preparedness• Poor training• No practice or rehearsal

While an Armed Intruder or Active Shooter inYOUR facility may be

“UNTHINKABLE”It can be managed with…

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EMERGENCY RESPONSEBASIC INCIDENT COMMAND STRUCTUREI

NCIDENT

COMMANDER

OPERATIONSSECTION

PLANNINGSECTION

LOGISTICSSECTION

FINANCE/ADMIN.SECTION

LIAISONOFFICER

SAFETYOFFICER

PUBLIC

INFORMATIONOFFICER

Nursing Home Incident Command System

http://www.cahfdisasterprep.com/NHICS/GuidebookTools.aspx

Situational Awareness:Part of Emergency Operations Plan Development!

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What If Your Facility Is Across The Street?

How Vulnerable Are They?

Terminology and Concepts


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Definitions

• Offender• Armed• Caregiver• Clear• Crime scene• Domestic dispute• Evidence• Facility

• Firearm• Lockdown• Mercy killing• Security• SWAT• Threat• Unified Command• Violent crime• Weapon• Witness


Definitions

Offender: The offender or perpetrator of anincident/event

Armed: The Offender carrying, displaying,and utilizing a weapon (primarily a firearm,but not always)

Caregiver: A healthcare worker (doctor,nurse, med tech, aide, social worker, etc.)

Clear: The methodical search of a facilityby law enforcement for additionalOffenders and threats

Crime scene: The exclusionary zone lawenforcement cordons off. Encapsulates thelocation of the crime and evidence to becollected

Domestic dispute: An emotionally chargeddispute between two or more persons engaged ina sexual, domicile, or family relationship;incident may have started off facility grounds

Evidence: Items that result from the planning,execution, and commission of a criminal act. Maybe material, electronic, statements, fluids, etc.

Facility: The structural location of employmentor physical location where an incident occurred


Definitions

Firearm: A gun; may be a handgun or long gun(shotgun or rifle)

Lockdown: An emergency safety procedureutilized by a facility to announce a threatwithin the facility, combined with a safetyaction plan to secure occupants until the threathas concluded

Mercy killing: A homicide committed toalleviate the suffering of the victim (usuallyfrom a medical condition)

Security: Persons tasked by the facility toensure the safety of employees, patients, andvisitors. Security may be a facility employee orcontracted staff (armed or unarmed)

SWAT: Special Weapons and Tactics. A highlytrained and equipped team of lawenforcement officers tasked to deal withhigh-risk threats

Threat: (v) Verbal, non-verbal, and otheractions expressing an intention to inflictfear, injury, or death; (n) the actual personcommitting the above

Unified Command: A shared incidentmanagement system in which two or moreofficers from different responding agenciesand functionality share managementresponsibilities from an establishedcommand post

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Definitions

Violent Crime: Defined by theDepartment of Justice as purse-snatching/pick-pocketing, assault(simple or aggravated), robbery,rape, and homicide

Weapon: Any item used to inflict fearin or cause injury to anotherindividual; may be defensive oroffensive (e.g., impact weapon,cutting weapon, weapon ofopportunity)

Witness: Any person having materialinformation about the planning orcommission of a crime. Statementsgathered from a witness during aninvestigation become evidence forprosecution or clearance of the crime

Characteristics of an Active Shooter

As with all aspects of human behavior, there is no 100percent “tried and true” characteristic of a shooter. Butwe still need to focus on behaviors, not profilesCommon characteristics include:

A “brittle” personalityFeelings of persecutionFeelings of injusticesSensitive to rejectionSelf-perception (outsider)Sees no other options

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Concepts

PHASE® Incident

CAVE® Incident

Rapid Response

Self Aid / Buddy Aid

PHASE® Incident

PHASE Incident

P: PersonalH: HostileA: AgendaS: SingularE: Event

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PHASE Incident

Personal: This incident is not random and occurs between knownpersons. The incident is driven by an emotional cause (passion, rage,love, revenge, etc.)

Hostile: The offender’s action toward the victim is driven by emotionand will be brutally violent

Agenda: The offender has a premeditated plan and has come to thefacility prepared to carry it out

Singular: The incident will be over once the agenda has beencompleted; not a continuous act

Event: The quantified incident

PHASE Incident Examples

PHASE® Incident

• Mercy killing• ‘Wrongful death’—targeting caregiver• Resident mistreatment/abuse• Domestic dispute• Child custody• Employee harassment• Employee termination

CAVE® Incident

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CAVE Incident

C: ContinuousA: ActiveV: ViolentE: Event

CAVE Incident

Continuous: The offender will continue the incident until (s)he isstopped by some outside forceActive: The offender’s agenda has no clear end point. (S)he mayhave an objective, but it is very broad and not clearly definedViolent: Because the objective is broad, the offender needs agrandiose method to carry it out (e.g., large quantities ofweapons, munitions, and possibly explosives). The method ofviolence delivery is usually well thought outEvent: The quantified incident

CAVE Incident Examples

• Mental illness• ‘Wrongful death’ (departmental-wide)• Resident mistreatment/abuse• Employee termination• Political agenda• Personal agenda

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Evolution of PHASE® into CAVE®

Evolution of PHASE® into CAVE® Incident

Can it evolve?• Mindset• Factors


Mindset• PHASE® characterizations review

• Personal• Emotions are HIGH!!!

• Agenda• Thorough pre-plan event• Determined• Resolute

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Factors prompting the evolution• Change of Heart

• Offender cannot kill himself – decidesto run

• Planned victim not there• Offender deep in building, might shoot

his way out• Murphy and his ruthless law

Rapid Response

Rapid Response

• A trained, coordinated law enforcement techniqueto respond to and mitigate the potentially highcasualty count from an active-shooter incident

• Developed after and due to the Columbine HighSchool mass shooting in 1999

• Primary objective: Enter the facility, proceed tothe sound of gunfire, stop the threat

• The initial entry team will bypass the woundedand those in need of help

• The second entry team is tasked with assistingthe wounded and directing evacuation

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Rapid Response

• Officers will be in different uniforms but will beclearly identifiable as police

• Follow law enforcement directions• Do not have any items in your hands• Keep your hands up. Try and remain calm• Do not run or make sudden movements toward

officers• Do not yell, scream, or speak with officers• Expect to be detained, searched, and questioned

Response to Law Enforcement Arrival

Self Aid / Buddy Aid (SABA)

Where will you be if it happens?

Self Aid / Buddy Aid (SABA)

A military and law enforcement technique now beingexpanded into the private sector that teaches care andtreatment basics for self survival and buddy survival. Topicsinclude:

• Controlling Bleeding• Direct Pressure or Pressure Bandage• Tourniquet Application and Use• Penetrating Chest Wound• Airway Management

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Individual SABA Trauma Kits

Case Study


Pinelake Health & RehabCarthage, NC

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Case Study:Pinelake Health & Rehab • Carthage, NC

• Skilled nursing, Alzheimer’s care, rehabilitation therapy,and hospice care

• 110 beds on campus• 90 resident beds• 20 special care (Alzheimer’s/dementia)

Facility Overview

Aerial View of Pinelake Health & RehabCarthage, NC


On Sunday, March 29, 2009, at approximately10:00 a.m., an act of violence at Pinelake Health &Rehab in Carthage, North Carolina ended several livesand wounded residents, staff, and a visitor—bothphysically and emotionally.

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• The gunman, Robert Stewart, arrives on location andparks in the front of the building

• Stewart fires multiple rounds into the PT Cruiser of hisestranged wife, who is an employee of the facility

• Before entering the building, Stewart shoots a visitor,Michael Cotton, in the shoulder

• Stewart enters the building to search for his estrangedwife, Wanda Stewart

• Unable to find her because she is in a locked dementiaunit, Stewart begins to shoot at residents and staff

Incident Overview


• Nurse Jerry Avant Jr. identifies the incident andmakes a facility-wide “lockdown” announcement

• Avant begins to move and secure residents but isshot by Stewart and later dies from the injuries

• A police officer arrives on scene and challengesStewart, who turns his gun at the officer

• The officer is shot, but returns fire, hitting andinjuring Stewart and stopping his attack

• The officer takes Stewart into custody

Incident Overview

Case Study:Pinelake Health & Rehab-Carthage, NC

Police Response: Cpl. Justin Garner

"He acted in nothing short of a heroic way today, and but for hisactions, we certainly could have had a worse tragedy," said Moore

County District Attorney Maureen Krueger. "We had an officer, a well-trained officer, who performed his job the way he was supposed to

and prevented this from getting even worse than it is now.“

www.wral.com/news/local/story/4837676/

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• 7 residents and 1 staff member killed• 3 injured, including the gunman• Stewart brought multiple firearms to

the facility and a bag of ammunition• 12-gauge shotgun• .22 caliber rifle• .22 Magnum semi-automatic pistol• .357 Magnum revolver

• The 12-gauge shotgun was Stewart’sprimary weapon of choice

Incident Discoveries and Aftermaths


LillianDunn, 89

JerryAvant Jr.,39, nurse

LouiseVocht De Kler, 98

Jessie V.Musser, 88

John W. Goldston, 78

Tessie Garner, 75

Bessie Hedrick, 78

Margaret Johnson, 89

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“

”

Robert Stewart entered Pinelake thatday with a specific reason—to chasedown Wanda Stewart. He brought fourguns and a bag of ammunition with theintent of creating mass casualties.

Opening statement to jurors by Tiffany Bartholomew, Assistant DistrictAttorney for Moore County, North Carolina, at the homicide trial of RobertStewart on August 1, 2011

Motive

“

”

Stewart doesn't recall what happened theday of the shooting and can't be held legallyresponsible for his actions. Stewartoverdosed on the sleep-aid Ambien the nightbefore the shootings and also was takingantidepressants at the time.

Attorney Jonathan Mergerian (defense attorney for Robert Stewart)

Defense Argument


On Saturday, September 3, 2011,Robert Stewart, 45, was foundguilty of second-degree murderfor killing eight individuals whilethe influence of antidepressantsand six (6) Ambien pills.

He was sentenced to 142 years in prison.

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Summary and Conclusions• A quick announcement of “Lockdown” by nurse Jerry Avant Jr. alerted

staff and residents, saving countless persons• Nurses and CNAs were able to secure and save many patients in locked

areas that were unable to be accessed by the gunman• A quick, composed response by a well-trained Carthage police officer

stopped the shooting rampage, preventing further casualties• Robert Stewart will spend the rest of his life in jail• Several families filed wrongful death civil suits against the parent company

of Pinelake Health & Rehab for lack of safety procedures and related issues

Decision Making and Stress Control


Active Shooter Safety Action Plan

Making the Decisions

“Making the ‘right’ decision quickly and devoid ofhesitation, under a great amount of stress, takes anunderstanding of how the decision-making processfunctions. This procedure must be understood andpracticed. Furthermore, there also needs to be anunderstanding of safety policy and protocols revolvingaround an active shooter threat in your facility. If youcan master both of these concepts, it will save lives.”

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Making the Decisions


Boyd’s Cycle of Decision-Making(OODA Loop)

USAF Colonel John Boyd


Boyd’s OODA Loop Cycleof Decision-Making

United States Air Force (USAF) Colonel John Boyd was a jet pilot andmilitary strategist in the 1960s . During the Korean War, he foundedand developed the OODA Loop cycle of decision-making, whichhelped Air Force pilots make decisions during air-to-air combat. TheUS pilots, flying the F-86 Sabre against the superior Russian MiG-15,were dominant because of the OODA Loop. It helped the pilots makerapid decisions and win the dog fights.

The US pilot who went through the OODA Loop cycle in the shortesttime prevailed because the MiG-15 pilot was caught responding tosituations that had already changed.

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Boyd’s OODA Loop Cycle of Decision-Making

Observe

Orient

Decide

Act


OODA Loop Cycle of Decision-Making

Observe• The ‘Observe’ segment of the OODA Loop is extremely important• Know that ‘Observe’ is not limited to sight and includes other senses• ‘Observe’ is the initial recognition of a PHASE® /CAVE® Incident• The faster ‘Observe’ is applied in a PHASE® /CAVE® Incident, the

more lives will be potentially saved

Observe


Orient• The ‘Orient’ segment of the OODA Loop follows ‘Observe’• ‘Orient’ will place you in perspective to the Offender’s position in

the facility and your position within the facility• ‘Orient’ will determine which leg of the STAF protocol you employ:

Resident Safety or Personal Safety (the STAF protocol will beexamined in subsequent slides)

Orient


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OODA Loop Cycle of Decision-MakingDecide• The ‘Decide’ segment of the OODA Loop follows ‘Orient’• Once the ‘Observe’ and ‘Orient’ segments of the cycle are complete,

‘Decide’ must be quickly chosen—Make a Decision!• Once designated, the ‘Decide’ segment must not vary—DO NOT BE

WISHY-WASHY!• Any decision is better then NO decision. The decision you make quickly will

save livesDecide



Act• The ‘Act’ segment of the OODA Loop follows ‘Decide’• Once the ‘Observe,’ ‘Orient,’ and ‘Decide’ segments of the cycle are

complete, ‘Act’ must be quickly executed without hesitation andwith total conviction

• ‘Act’ functions need to be trained and rehearsed to ensure thehighest survivability of residents, visitors, employees, and YOU

Act

Stress and Anxiety Reduction

Why do we need to practice and train?• Stress responses

• Heart rate• Breathing

• Stress inoculation• What is it?• How does it help?

Protocol

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Anxiety and Heart Rate

Siddle and Grossman 1997

Tactical Breathing

The 5-by-5 Rule• Inhale slowly while counting for five seconds• Hold that breath while counting for five seconds• Slowly exhale while counting for five seconds• Hold the ‘empty lungs’ while counting for five

seconds• Repeat

• This will decrease your heart rate• This will help you regain focus


• How to inoculate: TRAINING, PRACTICE and DRILLS• How would you react to an active shooter in your facility if you

were unprepared, not trained, and have never experienced thestresses of such an event? How would your anxiety, stress andfear be…could you think and function?

• Would your reaction be different to the event after training,practice and drills? Think about how you react to a lifethreatening medical emergency? Are you full of stress, anxietyand fear or do you function well because of training and lifeexperience during those events?

Stress Inoculation

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• Mental Imagery: Mental imagery helps you personallytrain without the formality of organized drills.

• During your shift, stop and ask yourself, what would I doright now if an “Armed Intruder/Active Shooter”announcement were made over the overhead PA system?

• Imagine the bad guy in different locations throughout the facility• Look at where staff members and residents are right at the time

of your mental imagery training…what would you do to increasethe survivability chances for them?

Stress Inoculation

“Awareness is good, but without skillsand ability tied to that awareness, all

you have is anxiety.”~ Tony Blauer

extreme close combat trainer



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• Exit the facility as quickly as possible• Leave personal belongings behind• Encourage people to go with you• Use the “bounding overwatch” technique to move

groups of people and yourself from point of cover tocover if you are not aware of the offender’s location

• Stay calm and quiet• When in a safe location, call 911• Follow police directions

Get Out

911

• Who should call 911?• Anyone and everyone!

• When should you call 911?• When it’s safe to do so!

• How should you call?• If possible, use a facility phone. This will allow the 911

operator to positively identify the address you are callingfrom without you having to give it

• If using a cell phone, the 911 operator may not be able toidentify your location unless you give them the address!

Things to remember regarding 911

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911

• Facility name and location• Your name• Nature of the event• Description of the subject or shooter (if known)• Type of weapon(s)• Persons injured—number and extent

Information to give the 911 Operator

Firearm Tutorial

• It is not important that you are a ‘firearm expert’ when givinginformation to the 911 operator

• You do not need to know make, model, or caliber• If possible, give the 911 operator the style of firearm

• Handgun: A firearm that can be held in one’s hand (e.g., a pistol orrevolver)

• Long gun: A firearm that is designed to be fired by mounting on one’sshoulder (e.g., a rifle or shotgun)

Firearm Styles

Handgun Long gunWeapon Types

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Get Out: The BoundingOverwatch


The Bounding Overwatch

• The Bounding Overwatch is a technique used by military and lawenforcement to safely move groups of soldiers or officers from onepoint of cover and concealment to another

• This technique, modified for you, uses the same practice—movingfrom one point of safety to another point of safety in small groupsor by yourself. You move to safely evacuate the facility

• When moving a group of people, do not move the entire group atonce. Break it up into smaller groups and coordinate movements


The Bounding Overwatch

Plan….Look….Move….Look….Move….GOAL!

• Have a PLAN• LOOK from a point of cover/concealment for an opportunity to move safely

to another point of cover/concealment…the OPPORTUNITY is to movewithout the bad guy seeing you!

• MOVE quickly and with conviction to the next point of cover andconcealment...stay low

• LOOK again from the new point of cover/concealment for an opportunityto move safely to another point of cover/concealment…the GOAL is to GetOut safely!

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Copi

er

Desk

Door toSafety


Get Out: The faster and smarter youmove to “Get Out,” the lower theprobability you will be shot by thebad guy. Moving targets are hardtargets to hit.


Statistically, trained and prepared lawenforcement officers involved in a gunfightonly hit 18 to 27% of targets.

The likelihood of being hit by a bullet firedby the offender during an Active ShooterEvent is low if you move quickly!

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• Inconspicuous place• Cover yourself• Call 911 if able and safe to do so• Be QUIET• Silence cell phones, pagers, etc.• Be still• Elevator or stairwell?• Hide in ‘plain sight’• Play dead

Hide Out

AnAwareness

Test

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• Hiding in Plain Sight• The bad guy is looking for targets of

convenience and opportunity• If you can hide out of the bad guy’s Line of

Sight, chances are low (s)he will not see you• Can be utilized to hide residents• Because of the police Rapid Response, the bad

guy will be moving quickly and not take timeto search for victims

Hide Out: It’s easy to miss somethingyou’re not looking for!

Two volunteers, please!!!


Hide OutHide in plain sight: deep corner

BadGuy’s

Line ofSight

Hallway

ResidentRoom

1

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COVER

• Hides you• STOPS Bullets

CONCEALMENT

• Hides you• DOES NOT STOP Bullets

VS.



• Lock/deadbolt• Big, heavy things

• Furniture (desks, bookshelves, etc.)• Medical equipment• Resident room beds

• Lots of smaller things• Body fluids: fecal matter???• Once secure, call 911

Keep Out

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Take Out

• The FIGHT of—and for—your LIFE• Commit to the act…• …and do not stop until the threat has ended• Misery LOVES company—strength in numbers• Weapons of opportunity in the workplace• Position of Tactical Advantage• Diversion and confusion prior to the fight• Speed, aggression, surprise


Take Out

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United Airlines Flight 9310:03 a.m. September 11, 2001

Todd M. Beamer

Bay County School Board Meeting • Panama City, FLTuesday, December 14, 2010 (approximately 2:00 p.m.)


Take Out: Weapons of Opportunity• What is a ‘Weapon of Opportunity’?

• A Weapon of Opportunity is any item in your immediate areathat can be crafted into a tool to defeat the bad guy

• What can be used as a ‘Weapon of Opportunity’?• Anything!! Look around now…what could you use to strike,

throw, stab, etc…at a bad guy if you had to?• Look for ‘opportunity’ to use a Weapon of Opportunity

Look for the Opportunity to use a Weapon ofOpportunity to create Opportunity for yourself and your

residents during Take Out!

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Weapons of Opportunity


You need to combine aand a

with a tosuccessfully defeat the Offender.


Take Out: Diversion

• Key component in a coordinated ‘Take-Out’ action plan• What is ‘diversion’?• What can be used for a ‘diversion’?• How can you use your tools of ‘diversion’?

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Exercise 2

We need a new bad guy.

Who feels like shooting up abunch of colleagues?

Safety Transition Adjustment Formula ProtocolSTAF-P


The Dilemma—What about my residents?!?!

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Resident Safety and Personal Safety Duringa PHASE® or CAVE® Incident

• Questions you will have to answer with little or no prep time:

• How do I protect myself?• How can I protect my residents?• When should I act?• How should I react?

Introducing the(STAF-P)

Resident Safety and Personal Safety Duringa PHASE® or CAVE® Incident

• A formula, driven by policy and training, that plansemployee actions during a fluid PHASE® or CAVE®incident, ensuring the maximum survivability chancesfor both residents and personnel

• Designed to save as many residents and personnelduring a PHASE® or CAVE® incident as possible

What is the Safety Transition AdjustmentFormula Protocol (STAF-P)?

SAFETY

EMPLOYEES

STAF-P

RESIDENTS

Safety Transition Adjustment Formula Protocol (STAF-P)“...balancing the safety of residents and employees”

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Safety Transition Adjustment Formula Protocol(STAF-P)

Response

ActiveThreat

Resident Safety Personal Safety

Distant Immediate

ActiveShooter

Safety ActionPlan


Time of Recognition• Employee awareness and recognition of a PHASE® or CAVE®

incident needs to be immediate• Employees need to identify and announce to the facility the

Offender’s location and intention• Employees need to move residents and visiting family members to

and secure them in areas of safety per the STAF protocol• When the offender breaches your area/wing/floor, transition from

resident safety to personal safety utilizing the Active ShooterSafety Action Plan


• Which residents do I attend to first?• How do I attend to them?• Know that you may not be able to secure all residents before the

Offender enters your area• The end goal of the STAF protocol is to save as many lives,

including yours, as possible during an incident in which theoffender is trying to take them!

Protocol

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• You are making decisions for the residents• Are you able to lockdown the entire unit/wing/floor and barricade

it?• If not, whom do I attend to first?

• Residents who are able to act without assistance followingcaregiver directive

• Ambulatory/mobile residents• ‘High-maintenance’ residents

Protocol


Active Shooter Rule of Thumb:

In the midst of a CAVE® incident, the active shooter will belooking for targets of convenience and opportunity. The shooteris looking for mass casualties. As (s)he moves from area to areain your facility, (s)he is not likely to take time to breech a dooror do a room-by-room search looking for victims. The shooterknows (s)he must move quickly before police intervene.

Washington, DC Navy Yard Shooting Surveillance Footage (September 16, 2013)

Source: FBI

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• Know your facility• Are you able to lock your wing or floor and keep the

Offender from gaining access?• Can you secure residents in their rooms?• Is there a room where you can ‘stash’ numerous residents

and lock the door?• Supply/janitor’s closet• Medication room• Records room• Bathrooms

• Hide ‘in plain sight’

Protocol: Hide Out/Keep Out

Policy Development and Training



• Why do we need a policy on Active Shooter Response?• Statement of purpose• Clearly defined protocol• Staff understand their roles• Minimizes confusion• Reduces liability• Saves lives!

Policy

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1. Conduct Security Vulnerability Assessment2. Develop An Active Shooter Emergency Response Plan3. Develop an Active Shooter Training Program4. Train Staff on How to Respond to an Active Shooter

Event5. Plan for Recovery

Five Steps to Protect Our Stakeholders

Even if this is a good depiction of your maintenancedirector, this does NOT represent a good site securityplan…...


Answers several key questions:1. From what and from whom should the healthcare

facility be protecting itself? (What are the THREATS)2. Where are the “chinks in the armor” that could allow

the event to occur (What are the VULNERABILITIES)3. What are the likely consequences in the event the

vulnerabilities are recognized and compromised? (Whatare the RISKS)

4. What can we do to minimize the vulnerability?

Step 1: Conduct a Security Vulnerability Assessment (SVA)

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Make it realistic to the threat:• PHASE® Event: Shooter has a specific target• CAVE® Event: Shooter looks for high body/casualty counts;

shoots as many as possible• There will be no “Code Team” responding• Chaos will reign• It may be only you and a colleague to get through this…alive

Step 2: Develop An Active Shooter Emergency Response Plan


• Develop plan with employees and residents in mind• Active Shooter Safety Action Plan• STAF-P

• Denial has no survival value It won’t happen here…

• Develop a plan with a survival mindset• Lines of survival: exits, hiding places, barriers, weapons of opportunities

Step 2: Develop An Active Shooter Emergency Response Plan


• Your training strategy:• Provide a range of options and choices for occupants to make decisions

• Survival is not a random outcome— survival is the result of trainingand preparedness!!!

• The four-step approach to training Awareness

• Preparedness• Drills and exercises

• Evaluations and improvements

Step 3: Active Shooter Training

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Training should be multilevel. Atnew employee orientation, all

new employees should go throughthe facility-wide program. Oncethey get to the particular unit inwhich they will be working, theyshould go through department-

specific orientation as on-the-jobtraining

Step 3: Active Shooter Training


• How do we practice and train?• Seminars• Tabletop exercises• Practical exercises

• How often do we need to practice and train?• Frequency should be clearly defined in policy• Biannual seminars/tabletop exercises• Annual practical exercises

Drills


• The first response to an active event is the same for TRAINED andUNTRAINED (and UNPREPARED) people …

Step 4: Active Shooter Response

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Trained and Prepared:• Anxiety• Recall what they

have learned• Ready to act as they have been trained

Step 4: Active Shooter Response

Untrained and Unprepared:• Panic• Frozen with fear; disbelief and

denial• Stay frozen in shock and denial


Step 5: Post-incident Recovery


Step 5: Post-incident Recovery

Recovery• Initiate the facility Crisis Management Plan

• Takes place after the event is over• Return to normal or safer state of affairs as

quickly as possible• May take days, months, or years• Key is evaluation of event and a recovery plan

in place BEFORE the event occurs

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Review

• PHASE® Incident/CAVE® Incident• Decision making/Stress Control• Active Shooter Safety Action Plan

• The 4 ‘Outs’: Get, Hide, Keep and Take

• Safety Transition Adjustment Formula(S.T.A.F.) Protocol

• Balancing Patient and Personal Safety• Decision making

• Policy Development and Training

Steve Wilder, President- [email protected]

www.swa4safety.com@SorensenWilder

800-568-2931

Armed Intruder and Active Shooter in theLong Term Care Environment:Plan... Respond… and Survive the Unthinkable

7/6/2016 - idaho health care association...7/6/2016 14 phase incident personal: this incident is not...

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